Individual
VIMALA SIVARAMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 VANTAGE CT, PORT JEFFERSON, NY 11777-2237
(631) 331-2422
Mailing address
PO BOX 638, PORT JEFFERSON, NY 11777-0638
(631) 331-2422
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
173991-1
NY
Other
Enumeration date
10/20/2015
Last updated
10/20/2015
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